Sen. Marshall’s Bill Prioritizing Patients over Paperwork Moves One Step Closer to POTUS’ Desk

Movement Comes Following Announcement that 500+ Advocacy Groups Announce Support

(Washington, D.C., July 27, 2022) – U.S. Senator Roger Marshall, M.D. (R-KS) released a statement following the U.S. House Ways and Means Committee passage of his Improving Seniors’ Timely Access to Care Act. This bipartisan, bicameral legislation is aimed at modernizing Medicare Advantage to make health care delivery more patient and doctor friendly.

“For nearly four years, my colleagues and I have worked tirelessly on bipartisan legislation to modernize Medicare Advantage to better serve America’s seniors, said Senator Marshall “We reviewed comments from over 450 national and state organizations, took feedback from two Administrations, and worked collaboratively with House and Senate Committee leaders. Its significance to patients, health care providers, and innovators in medicine cannot be understated – this is the most supported health care bill in the entire Congress. I’m honored to have started this journey with Representatives Suzan DelBene, Mike Kelly, and Ami Bera years ago, and I am honored to continue working on this bill with Senators Kyrsten Sinema, John Thune, and Sherrod Brown. Today marks an important step forward. I urge leadership to prioritize moving our bipartisan, bicameral bill to the President’s desk.”

Background:

Today’s announcement comes on the heels of over 500 organizations that represent patients, physicians, hospitals, and other key stakeholders in the health care industry officially endorsing the legislation since its introduction. You may click HERE for a full list of organizations that have announced support for the Improving Seniors’ Timely Access to Act.

The legislation is led by the Senator alongside Kyrsten Sinema (D-AZ), John Thune (R-SD), and Sherrod Brown (D-OH) and U.S. Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, M.D. (D-CA), and Larry Bucshon, M.D. (R-IN).

The bill was ordered out of Committee unanimously with several members touting support for the long overdue action. During the markup, Representative DelBene recognized Senator Marshall for his leadership as a co-lead during his time in the House chamber last Congress. She praised his leadership and efforts in the Senate, stating that his experience as a physician had been invaluable throughout this process.

Recently Drs. Jonathan Crowe and David N. Bernstein praised Senator Marshall’s legislation in a FOX News Op-ed saying in part, “…U.S. Senator Dr. Roger Marshall’s Improving Seniors’ Timely Access to Care Act of 2021 is a bipartisan, bicameral bill with support in both chambers… By passing this legislation, Congress can send President Joe Biden a bill that creates a health system that is more efficient, less expensive, and focused on getting patients the care they need. His signature on this legislation would send a welcome message of support to patients and health care professionals. By taking these steps, we can move away from an outdated system that delays patient care and contributes to physician burnout. The lives of our nation’s patients and doctors may depend on it.”

Prior authorization is a tool used by health plans to reduce spending from improper payments and unnecessary care by requiring physicians and other health care providers to get pre-approval for medical services. But it’s not without fault. The current system of unconfirmed faxes of a patient’s medical information or phone calls by clinicians takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers and nearly four out of five Medicare Advantage enrollees are subject to unnecessary delays. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied.

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization. Building on these principles, the bipartisan legislation would:

• establish an electronic prior authorization process that would streamline approvals and denials;
• establish national standards for clinical documents that would reduce administrative burdens for health care providers and Medicare Advantage plans;
• create a process for real-time decisions for certain items and services that are routinely approved;
• increase transparency that would improve communication channels and utilization between Medicare Advantage plans, health care providers, and patients;
• ensure appropriate care by encouraging Medicare Advantage plans to adopt policies that adhere to evidence-based guidelines; and
• require beneficiary protections that would ensure the electronic prior authorization serves seniors first.

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